Abstracts

Temporal lobe epilepsy is the most common type of intractable seizure disorder. Seizure semiology has been shown to improve the localization of seizures for the purpose of selecting candidates for temporal lobectomy. There are no studies to date that compare the clinical manifestations of seizures occurring during wakefulness with those of seizures arising from sleep in the same temporal lobe epilepsy patient. Inclusion study criteria were: 1) excellent outcome following left or right temporal lobectomy ; 2) age of [gt]5 years; 3) both wake and sleep seizures recorded by video-EEG; 4) recordings available for review; 5) no other seizure focus identified. Thirty patients from our epilepsy surgery database consecutively met the inclusion criteria.
Video-EEG recordings of wake and sleep seizures were reviewed and compared in detail. Subjects consisted of 12 males and 18 females. Nineteen had left temporal lobectomy. Average age was 29.7 years. There was no statistically significant difference in the following semiologic manifestations: early unforced head turn, unilateral automatism, contralateral immobile limb, ictal speech retention, dystonic limb, tonic limb, clonic activity, late forced head turn, [ldquo]fencing[rdquo] posture, [ldquo]figure 4[rdquo] posture, second late forced head turn, asymmetric clonic ending, Todd[apos]s paresis, postictal nose wiping or postictal dysphasia. Mean seizure duration was 71.7 seconds during wakefulness vs. 88.7 seconds during sleep. The difference was not statistically significant (p[gt]0.05). Within each temporal lobe epilepsy surgery patient, there is no difference in semiology between seizures that occurred during wakefulness and seizures that occurred during sleep. Temporal lobe seizures arising from sleep has localizing value similar to that of temporal lobe seizures occurring during wake.